VENTILATORY SUPPORT STRATEGIES FOR DIFFERENT CAUSES OF RESPIRATORY FAILURE

Question 1

It occurs when
the respiratory system cannot maintain adequate gas exchange, leading to insufficient oxygen levels in the blood or elevated carbon dioxide levels, or both.

Answer 1

Respiratory Failure

Question 2

2 Main Goals of Ventilatory Support

Answer 2

1. Restore Adequate Gas Exchange
2. Reduce Work f Breathing

Question 3

Restoring Adequate Gas Exchange:

• Achieving sufficient oxygenation
  (PaO₂ of ______ or SpO₂ of _____)
  to prevent hypoxic injury.
• Reducing _____________________ in hypercapnic failure.

Answer 3

• Pa02 of > 60 mmHg
  Sp02 of > 90%
• Reduce PaC02 to normal or target range.

Question 4

What main goal of Ventilatory Support is this ?

• It assist or replace the effort of breathing
  to prevent respiratory muscle fatigue.
• Supports weakened or compromised respiratory
  muscles, especially in neuromuscular conditions.

Answer 4

Reduce work of breathing

Question 5

• Failure due to insufficient oxygenation despite normal ventilation
• also called Hypoxemia

Answer 5

Type 1 RF

Question 6

It often results from V/Q mismatch or diffusion defects.

Answer 6

Type 1 RF

Question 7

Widespread inflammation

= increase permeability of A/C membrane.
= increase accumulation of fluid in the alveoli.
= minimize/decrease the space/surface area which we use for gas exchange.
= HYPOXEMIA

Answer 7

ARDS

Question 8

__Infection in the lungs__

= Alveolar consolidation
filling of alveoli with different substances s/a: Fluid, Puss, Blood
= Parts of the lungs that are consolidated can’t participate in gas exchange. (V/Q mismatch)

Answer 8

Pneumonia

Question 9

__Blood Clot__

originates from Deep Vein Thrombosis

Block pulmonary arteries
= Blockage
= V/Q mismatch
Enough ventilation but not enough perfusion.

Answer 9

Pulmonary Embolism

Question 10

Accumulation of fluid in the alveoli & interstitial space

Answer 10

Pulmonary Edema

Question 11

TARGET:
Maintain oxygenation while minimizing ventilator-induced lung injury (VILI).

What strategy is this for?

Answer 11

VENTILATORY STRATEGY FOR ARDS

Question 12

VENTILATORY STRATEGY FOR ARDS

Approach:

Answer 12

1. Low Tidal Volume Ventilation
2. PEEP Optimization
3. Prone Positioning
4. Fi02/PEEP titration
5. Consider ECMO

Question 13

VENTILATORY STRATEGY FOR ARDS

Approach:

1. (LTVV):________ml/kg ideal body weight
   to prevent overdistension.
2. _______ cmH20 normal PEEP used in ARDS.
   To prevent alveolar collapse.
3. This positioning is recommend for ARDS. It improves oxygenation by redistributing lung perfusion?
4. Adjust Fi02/PEEP to maintain
   Pa02 of _____mmHg or Sp02 of _____%
5. ECMO meaning? Use of ecmo?

Answer 13

1. 4-6ml/kg
2. 5-15 cmH20
3. Prone Positioning
4. Pa02 of >55mmHg or Sa02 of >88%
5. ExtraCorporeal Membrane Oxygenation.
   It is used in severe cases of hypoxemia

Question 14

Restore oxygenation and reduce patient work of breathing.

What ventilatory strategy is this for?

Answer 14

VENTILATORY STRATEGY FOR PNEUMONIA

Question 15

VENTILATORY STRATEGY FOR PNEUMONIA

Approach:

Answer 15

1. Non-Invasive Positive Pressure Ventilation (NIPPV)
2. PEEP
3. Higher Fi02
4. Monitor hypercapnia

Question 16

VENTILATORY STRATEGY FOR PNEUMONIA

Approach

1. Use _____ or _____ if px is hemodynamically stable.
2. PEEP for pneumonia (________cmH20) to prevent alveolar collapse.
3. Ensure Pa02 of ______mmHg or Sp02 of _____%.
4. If hypercapnia is severe you need to switch to?

Answer 16

1. CPAP or BiPAP
2. 5-10 cmH20
3. Pa02 of > 60 mmHg or Sp02 of 92%
4. Invasive ventilation

Question 17

Improve oxygenation, manage ventilation, and reduce the workload on the heart.

What ventilatory strategy is this for?

Answer 17

VENTILATORY STRATEGY FOR
PULMONARY EMBOLISM

Question 18

VENTILATORY STRATEGY FOR
PULMONARY EMBOLISM

Approach:

Answer 18

1. Low Tidal Volume
2. Set Moderate PEEP

Question 19

VENTILATORY STRATEGY FOR
PULMONARY EMBOLISM

Approach

2. PEEP for Pulmonary Embolism
   ( ________cmH20)
   - What to avoid using in pulmonary embolism?
   - What is compromised if you don’t avoid it?

Answer 19

2. 5-10 cmH20
   - Avoid using increased PEEP in pulmo embolism
   - Hemodynamic status

Question 20

Improve oxygenation and reduce work of breathing.

What ventilatory strategy is this for?

Answer 20

VENTILATORY STRATEGY FOR
PULMONARY EDEMA

Question 21

VENTILATORY STRATEGY FOR
PULMONARY EDEMA

Approach:

Answer 21

1. CPAP or BiPAP
2. PEEP
3. Fluid Management
4. Diuretics and Vasodilators

Question 22

VENTILATORY STRATEGY FOR
PULMONARY EDEMA

Approach

1. It relieves dyspnea and reduce intubation
2. It helps recruit alveoli and
   redistributes fluid in lungs?
3. Key to preventing worsening edema?
4. Expell the excess fluid in the form of urine

Answer 22

1. CPAP or BiPAP
2. PEEP
3. Fluid Management
4. Diuretics

Question 23

This type of RF results from inadequate alveolar ventilation, leading
to CO₂ retention.

Answer 23

Type 2 RF

Question 24

Causes of Type 2 RF

Answer 24

1. COPD
2. Asthma
3. Neuromuscular Disease

Question 25

Correct hypercapnia and relieve respiratory distress without over-distending lungs.

What ventilatory strategy is this for?

Answer 25

VENTILATORY STRATEGY FOR COPD

Question 26

VENTILATORY STRATEGY FOR COPD

Approach:

Answer 26

1. Non-Invasive Ventilation (NIV)
2. Low Tidal Volume
3. PEEP
4. Fi02

Question 27

VENTILATORY STRATEGY FOR COPD

Approach

1. What is the preferred mode & why?
2. Low Vt To avoid ________.
3. Applied carefully and typically at lower levels to prevent exacerbation of auto-PEEP.
4. Start low, titrate based on SpO₂ or PaO₂ to avoid hyperoxia-induced hypercapnia.

Answer 27

1. BiPAP, it has 2 pressure supports (Inspiratory & Expiratory)
2. Auto-PEEP or Airtrapping
3. PEEP
4. Fi02

Question 28

Minimize barotrauma and avoid dynamic hyperinflation.

What ventilatory strategies are this for?

Answer 28

1. VENTILATORY STRATEGY FOR ASTHMA
2. VENTILATORY STRATEGY FOR NMD

Question 29

VENTILATORY STRATEGY FOR ASTHMA

Approach:
1. To prevent high airway pressures. (^levels of PaC02)
2. Allows prolonged expiration.
3. Limit to prevent lung injury.
4. Can worsen air trapping in severe cases.

Answer 29

1. Permissive Hypercapnia
2. Low Respiratory Rate
3. Monitor PIP
4. Avoid High PEEP

Question 30

VENTILATORY STRATEGY FOR NMD

Approach:

1. CPAP or BiPAP to support weakened muscles.
2. If patient cannot maintain spontaneous breaths.
3. It is adjusted based on individual’s lung compliance and avoid over-distension.
4. For secretion clearance in patients with weak
   Cough

Answer 30

1. NIV for Early Intervention
2. Invasive Ventilation for Severe Cases
3. Tidal Volume
4. Use for Cough Assist